Purpose <p>To compare complication rates and their impact on visual and refractive outcomes of laser in-situ keratomileusis (LASIK) <i>vs</i>. Small Incision Lenticule Extraction (SMILE) Corneal Surgeries in Saudi Arabia.</p> Methods <p>The cohort consisted of Saudi patients who underwent LASIK (Gr1) and SMILE (Gr2) refractive surgeries in 2023–2024. Demographic data, preoperative ocular status, types of complications during surgery, and one-month post-surgery outcomes were noted. Efficiency-1 was defined as achieving a 0.0 LogMAR uncorrected visual acuity (UCVA) after surgery. Efficiency-2 was post-surgery spherical equivalent of &lt; ± 0.5D. The determinants of complications and efficiency were reviewed.</p> Results <p>Gr1 and Gr2 included 324 eyes of 164 and 487 eyes of 247 myopic persons. Gr1 and Gr2 differed significantly in age, gender, visual impairment grade, refractive status, CCT, and UCVA. Only 3.1% of eyes had sight-threatening complications, and the others had transient complications. Complication rates were higher in Gr1 than in Gr2. [RR = 1.47, (95% CI 1.0; 2.2), <i>P</i> = 0.05]. The efficiency-1 in Gr1 and Gr2 was 96.6% and 96.3%. [Risk Ratio = 0.78 (95% CI 0.3; 2.0), <i>P</i> = 0.63]. The presence of complications was not significantly associated with the differential Efficiency1 in the two groups (<i>P</i> = 0.06). The efficiency 2 in Gr1 and Gr2 in eyes with complications was 2% and 12% better than in eyes without complications (<i>P</i> = 0.25).</p> Conclusions <p>Both LASIK and SMILE are effective for managing refractive errors. To achieve spectacle-free functional vision, a surgeon should prefer SMILE over LASIK surgery for myopia correction. Thin corneas and extreme preoperative refractive error negatively affected outcomes. Transient complications, if managed appropriately, do not result in sight-threatening disabilities.</p>